0:01

So this is another case here with the

0:03

cystic region in the pancreas, and we are

0:06

trying to characterize what exactly it is.

0:08

As we move here, we can see that

0:10

there are multiple lesions; those

0:12

are arising from the side branches.

0:14

So they are classical side-branch IPMNs; we can

0:16

demonstrate the communication with the main duct.

0:19

But as we go further to the pancreatic

0:22

head, we see this huge lesion with

0:26

multiple lobulated outlines and central

0:29

scar, which is T2-weighted hypointense.

0:32

And that shows tiny cysts inside,

0:35

packed together very closely,

0:37

and separated by thin septa inside.

0:41

So this looks like a classical honeycombed

0:42

appearance with centerless scar.

0:46

And if we have a CT scan, possibly we

0:47

will see calcifications here.

0:49

But that can be sometimes seen on

0:52

T1-weighted images if we can find.

0:56

So there is some kind of artifact

0:57

here that can be calcification.

1:01

But tough to predict without,

1:02

without seeing CT here.

1:05

And as we move to post-contrast images, we can see

1:10

those thin separations are minimally enhancing,

1:13

but we can actually appreciate that honeycombed

1:16

appearance very well on post-contrast images.

1:19

And this is the central scar,

1:20

which is also enhancing.

1:23

This is delayed phase, more enhancement of

1:27

the central scar with some non-enhancing

1:30

foci; those are likely calcifications.

1:33

So this is a classical textbook picture of

1:36

a serious tumor in the pancreas with

1:40

honeycombing appearance and central scarring,

1:42

situated in the pancreatic head or proximal

1:45

pancreas; and then we have some coexisting

1:49

side-branch IPM in the same patient.